Undiagnosed AIDS in patients with progressive dyspnoea: an occupational risk for healthcare workers in Croatia.
Arh Hig Rada Toksikol 2011;
62:57-64. [PMID:
21421534 DOI:
10.2478/10004-1254-62-2011-2071]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3 and 4. It is not unusual that these patients, most of whom do not know that they are already HIV-infected, are first examined and hospitalised by respiratory medicine specialists. While HIV-infection is relatively simple to diagnose if accompanied by advanced clinical manifestations and is regularly checked in patients with increased risk, this is not the case in low-risk patients, particularly in countries with low-level HIV epidemic and therefore low index of suspicion. Regular examination involves a series of tests, often including bronchoscopy with transbronchal lung biopsy in order to identify an interstitial lung disease and/or progressive dyspnoea. It is not uncommon that patients provide false or incomplete information about their lifestyle, which can mislead the clinician. At this point, HIV-infection is usually not suspected and healthcare workers may not strictly be following the safety principles which are otherwise applied when HIV-infection is known or suspect, although universal precautions are routine practice. At this point, the risk of exposure is the highest and HIV-transmission to healthcare workers is the most likely to occur. The cases presented here indicate that patients with progressive dyspnoea, which is typical of interstitial lung diseases, should undergo HIV-testing as a part of good clinical practice, even in a country with low-level HIV epidemic.
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